Aims: The study attempts to deal with the question what does the fact of spreading malaria among children take in its relationships with the ecological condition of a hyperendemic area. Specifically, the paper intends (i) to reveal the characteristics of childhood malaria epidemiology and (ii) to examine how ecological condition contributes to epidemiology having such characteristics.
Methods: Data have been recently collected in the Chittagong Hill Tracts (CHT), a hyperendemic area of Bangladesh through blood slide +ve Pv, Pf and Pv+Pf; rapid diagnostic tests +ve Pv, Pf, and Pv+Pf; CSP-ELISA; survey, interviews; expert consultations; and literature reviews.
Results: Of total malaria case in Bangladeshi children, the largest portion (92.90%) happens in the CHT and neighboring districts. The spread tends to be rather a complex and is characterized by age based nature, seasonal epidemic cycle, diverse anopheline species, Pf Pv coexistence, and multileveled consequence. In one of three CHT districts, the cases (N=83031) of last 5 years were distributed in 5 age groups: 1 yr, 1-4 yr, 5-14 yr, 15 +yr and pregnant women. The incidence of malaria transmission reaches an epidemic peak from June to August contrasting with hiatus of infections during late autumn, winter and early spring. 15 (0.6%) anophelines belonging to eight species were positive for infection. Pf Pv coexistence was rated 25%. The multileveled consequence includes uncomplicated, severe and vivax morbidities, and mortality.
Conclusions: With empirical evidence, the paper goes with the fundamental inference ‘malaria occurs in a patterned way that is determined by ecology’ in which malaria epidemiology is rooted. All of above, ecological settings and children’s traits are of critical importance for the understanding of elimination of malaria in a hyperendemic area, for instance, the CHT.